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Foreign bodies in the eye can often lodge itself in the adnexae of the eye and not just in the cornea. A thorough history and examination can often aid in detecting these usually non-obvious materials.
A 56-year-old woman presented with an acute red eye of a day's duration. She was having persistent discomfort and pain in her eye. She had been initially seen by her general practitioner who was unable to locate a foreign body on the cornea.
History revealed that she had a haircut earlier that day after which her symptoms started. Slit-lamp examination showed that a tiny cut hair end had lodged itself in the upper lacrimal punctum. This was removed with a forceps. No other ocular trauma was noted.
Although eyelashes have been known to trap itself in lacrimal punctums,1 ,2 this was a short hair fragment from the scalp that was thicker and more rigid in structure. Tears naturally wash out foreign debris but in this scenario, the hair end got caught up in the lacrimal flow and the negative pressure created with each blink cycle3 likely drew the hair in (figure 1).
From the history we were able to be more specific in our examination and on everting the upper lid, an embedded hair end was clearly seen in the right upper punctum. This was removed fairly easily with immediate relief to the patient and also with much clinician satisfaction.
A careful history will aid in characterising the type of foreign body that we are looking for.
Foreign bodies can be hiding in the adnexae of the eye and a thorough slit-lamp examination is important.
Hair from the scalp is rigid and sharp and can cause a lot more discomfort than a trapped eyelash in the eye.
With thanks to Dr Ameera Brett for assisting with the photograph.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.